House Bill Would Overhaul Medicare Advantage Stars
A House bill calls for the overhaul of the Medicare Advantage (MA) Stars program. Rep. Mike Kelly, R-PA, is sponsoring the Medicare Advantage Strengthening Transparency and Accountability in Rating Systems Act (MA STARS Act). It directs the federal government to rewrite Star ratings policy beginning with the 2031 contract year.
CMS would have to exclude any measure that is unrelated to clinical quality, outcomes, or experience. Member surveys would be reformed. Measures that no longer distinguish performance among most contracts would be barred. New measures could be added only if they relate to clinical quality, outcomes or experience.
The truth is that the Centers for Medicare and Medicaid Servies (CMS) has implemented most of the bill’s parameters. It has promulgated a rule that eliminates operational measures as well as those that do not have substantive differences between contracts. The CMS Stars restructure is scheduled to go into effect for Measure Year 2027/Star Year 2029. It faces litigation related to how it has promulgated Star requirements in the past as well as for statutory deficiencies in the current program. Lawsuits are pending for Star Years 2026 and now 2027. More are likely.
Star performance remains poor with the average rating in Star Year 2027 dropping from 4.01 to 3.99.
#stars #cms #medicareadvantage #quality
Centene, Oscar Announce 2027 Exchange Strategies
Both Centene and Oscar announced their plans for the Exchanges nationwide for 2027.
Number 1 player Centene will exit the Exchange markets in Delaware and New Hampshire in 2027. The insurer is expanding its plans to 1,740 counties across 27 states, adding 40 counties from its 2026 footprint. The company has 3.5 million Exchange members.
Centene is reducing both its Medicaid and Medicare Advantage (MA) footprints. Centene will exit the California and Oregon group markets and withdraw from the Arkansas Medicaid expansion and Hawaii Medicaid markets in 2027. It will also exit MA in Oklahoma, Tennessee, and Hawaii.
Oscar Health will offer plans in 713 counties across 21 states for 2027, a 24% increase in the number of counties it serves.
Additional article: https://www.modernhealthcare.com/insurance/mh-centene-aca-delaware-new-hampshire-2027/
#exchanges #enrollment #coverage #centene #oscar
https://www.fiercehealthcare.com/payers/centene-oscar-health-outline-2027-aca-marketplace-plans
— Marc S. Ryan
